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General NPI Number Information
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NPI Number | 1255509196
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Entity Type | Organization
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Legal Business Name | JAMES PRUCHNIEWSKI DPM PA
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 4973 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3657
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Country | US
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Telephone | 863-859-4434
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Fax |
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Provider Business Mailing Address
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Address Line | 4973 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3657
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Country | US
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Telephone | 863-859-4434
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES F PRUCHNIEWSKI
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Credential | DPM
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Telephone | 863-859-4434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PO1910
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License Number State | FL
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